This proposal is a request for an ADAMHA SDAC. The main objective is to establish an extensive educational and training program to foster the development of the Principal Investigator as an Independent clinician/researcher In the fields of family and psychosocial process, specifically as they are understood through their Impact on the outcome of chronic medical and psychiatric Illness. David Reiss, M.D., Director of the Center for Family Research and Professor In the Department of Psychiatry at George Washington University, will serve as sponsor for the duration of this award. The career development plan for the Principal Investigator is aimed at the achievement of three broad objectives: 1) competency in the knowledge and skills of scientific Inquiry 2) ability to use theory and data to expand the field of psychosocial processes which Influence medical and psychiatric disorders 3) experience in planning, executing and formulating the results of a research project. These objectives will be achieved through didactic course work, and through collaboration with an ongoing, intensely productive group at the Center for Family Research. Mavis Hetherington, Ph.D., Department of Psychology at the University of Virginia.,will serve as a mentor in longitudinal studies of family psychology. The proposed research is a study of the family processes of women with breast cancer. It is founded on recent data suggesting that psychosocial characteristics of the individual patient are predictive of disease progression and that psychosocial interventions can modify the course of metastatic breast cancer. This research will evaluate 150 women with breast cancer, 75 of whom are newly diagnosed and 75 of whom have new recurrence of disease. Family processes will be investigated by using self-report and observational measures which have shown promise in predicting outcome of other chronic diseases. The psychosocial factors of the individual patient, found to be predicitive in other research, will be replicated along with the exploration of family processes. The impact of both individual and family factors on disease progression will be assessed in this prospective longitudinal investigation. In summary, this work is intended to provide a new window for understanding coping with illness through this study of psychosocial processes linked to disease outcome.